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Reseller Report Form
Upon sending, Kindly wait for the response for the Warranty Reference #.
Email address
Name of Company:
Your answer
Contact #:
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Reported By:
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Reported Date:
MM
/
DD
/
YYYY
Date of Purchase:
MM
/
DD
/
YYYY
DR #:
Your answer
Model of Unit:
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Serial Number:
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Problem Encountered:
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